Value of C-reactive protein in differentiation between tuberculous and malignant pleural effusion
Egyptian Journal of Bronchology volume 11, pages 49–55 (2017)
Few studies had reported the value of Creactive protein (CRP) in differentiating between tuberculous pleural effusion (TBPE) and malignant pleural effusion (MPE).
The aim of this study was to investigate the diagnostic value of CRP in differentiating between TBPE and MPE.
Settings and design
This prospective study was conducted in a University Hospital.
Patients and methods
During a period of 18 months, a prospective study included 59 adult patients with pleural effusion. The study included two groups: group I, which included 29 patients with TBPE, and group II, which included 30 patients with MPE. Serum C-reactive protein (s-CRP) and pleural fluid C-reactive protein (p-CRP) were measured and compared in both groups, using enzyme-linked immunosorbent assay.
The mean values of s-CRP were 28.34±14.41 and 27.87±13.21 mg/dl in TBPE and MPE, respectively, with no significant difference. The mean values of p-CRP were 36.51 ±3.91 and 26.39±7.57 mg/dl in TBPE and MPE, respectively, with a highly significant difference (P=0.001). There were significantly positive correlations between s-CRP and p-CRP in both TBPE and MPE (r=0.685 and P=0.001; r=0.594 and P=0.006, respectively). With the use of cutoff values of 31.6 and 43.3 mg/l for p-CRP and s-CRP, sensitivity and specificity were 89.47 and 80.00% for p-CRP, and 15.79 and 100.00%, respectively, for s-CRP. The area under the receiver operating characteristic curve of p-CRP was 0.888, superior to that of s-CRP (0.525).
Measurement of CRP levels in the pleural fluid has a good utility in the diagnostic workup of patients with pleural effusion. p-CRP can be a useful adjunctive test, as a potential differentiator between TBPE and MPE.
Kapisyzi P, Dikensoy Ö, Argjiri D. Acute inflammation biomarkers in pleural effusions. Derleme 2012; 13:53–55.
Porcel JM. Pearls and myths in pleural fluid analysis. Respirology 2011; 16:44–52.
Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003; 111:1805–1812.
Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340:448–454.
Smith RP, Lipworth BJ. C-reactive protein in simple community-acquired pneumonia. Chest 1995; 107:1028–1031.
Abu-Youssef H, Amin S, Amin H, Osman E. Value of C-reactive protein in etiologic diagnosis of pleural effusion. Egypt J Bronchol 2010; 4: 124–130.
Samaha HMS, Elsaid AR, Elzehery R, Elhelaly R. C-reactive protein and serum amyloid A levels in discriminating malignant from non-malignant pleural effusion. Egypt J Chest Dis Tuberc 2015; 64:887– 892.
El-Shimy WS, Attia GA, Hazzaa SM, Mansour YM, Abd El-Halim WM. Diagnostic value of procalcitonin and C-reactive protein in differentiation between some benign and malignant pleural effusions. Egypt J Chest Dis Tuberc 2014; 63:923–930.
Chierakul N, Kanitsap A, Chaiprasert A, Viriyataveekul R. A simple Creactive protein measurement for the differentiation between tuberculous and malignant pleural effusion. Respirology 2004; 9:66–69.
Sedky M, Radwan I, Mohamed M. C-reactive protein in differentiation between tuberculous and malignant pleural effusions. Eur Respir J 2011; 38:2715.
Light RW. Clinical practice. Pleural effusion. N Engl J Med 2002; 346:1971–1977.
Steel DM, Whitehead AS. The major acute phase reactants: C-reactive protein, serum amyloid P component and serum amyloid A protein. Immunol Today 1994; 15:81–88.
Pepys MB, Baltz ML. Acute phase proteins with special reference to Creactive protein and related proteins (pentaxins) and serum amyloid A protein. Adv Immunol 1983; 34:141–212.
Vigushin DM, Pepys MB, Hawkins PN. Metabolic and scintigraphic studies of radioiodinated human C-reactive protein in health and disease. J Clin Invest 1993; 91:1351–1357.
Garcia-Pachon E, Soler MJ, Padilla-Navas I, Romero V, Shum C. Creactive protein in lymphocytic pleural effusions: a diagnostic aid in tuberculous pleuritis. Respiration 2005; 72:486–489.
Park DS, Kim D, Hwang KE, Hwang YR, Park C, Seol CH, et al. Diagnostic value and prognostic significance of pleural C-reactive protein in lung cancer patients with malignant pleural effusions. Yonsei Med J 2013; 54:396–402.
Elsammak MMY, Morsi TS, Khamis HI, Ragab MS, Zaki MA, Abdel-Hadi M, Hassan HA. Osteopontin and C-reactive protein in Egyptian patients affected with tuberculous and malignant pleural effusion. Ann Clin Biochem 2007; 44(Pt 3):264–272.
Heikkilä K, Ebrahim S, Lawlor DA. A systematic review of the association between circulating concentrations of C reactive protein and cancer. J Epidemiol Community Health 2007; 61: 824–833.
Scott HR, McMillan DC, Forrest LM, Brown DJ, McArdle CS, Milroy R. The systemic inflammatory response, weight loss, performance status and survival in patients with inoperable non-small cell lung cancer. Br J Cancer 2002; 87:264–267.
Botana-Rial M, Casado-Rey P, Leiro-Fernández V, Andrade-Olivié M, Represas-Represas C, Fernández-Villar A. Validity of procalcitonin and C-reactive protein measurement when differentiating between benign and malignant pleural effusion. Clin Lab 2011; 57:373–378.
Turay YU, Yildirim Z, Turkoz Y, Biber C, Erdogan Y, Keyf AI, et al. Use of pleural fluid C-reactive protein in diagnosis of pleural effusions. Respir Med 2000; 94:432–435.
Ji Q, Huang B, Wang M, Ren Z, Zhang S, Zhang Y, et al. Pleural fluid prealbumin and C-reactive protein in the differential diagnosis of infectious and malignant pleural effusions. Exp Ther Med 2014; 7:778–784.
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Mohamed, S.A.A., Agmy, G.R., Wafy, S.M. et al. Value of C-reactive protein in differentiation between tuberculous and malignant pleural effusion. Egypt J Bronchol 11, 49–55 (2017). https://doi.org/10.4103/1687-8426.198999
- C-reactive protein
- pleural effusion